Use of Home Peritoneal Dialysis by Cuba's Nephrology Institute, 2007-2012.

INTRODUCTION: Peritoneal dialysis is a maintenance therapy option for patients with end-stage renal disease. Continuous ambulatory peritoneal dialysis in Cuba was introduced in December 2007, and automated peritoneal dialysis one year later. This paper presents the outcomes attained with this blood purification technique, enabling an assessment to decide on scaling up its use in Cuba. OBJECTIVE: Describe the clinical course of patients in the first five years of the Home Peritoneal Dialysis Program at Havana's Nephrology Institute. METHODS: An observational, descriptive study with a retrospective cohort was conducted. The universe comprised the 40 Nephrology Institute patients who underwent treatment with home peritoneal dialysis from December 20, 2007 to December 20, 2012. Relative and absolute frequencies were calculated for the study variables and the Kaplan-Meier method was used for survival curves for patients and for the peritoneum as dialysis membrane. RESULTS Of the 40 patients in the program, 23 were men and 17 were women, primarily aged 40 to 59 years. The most frequent causes of chronic kidney failure were hypertension (42.5%), glomerulopathies (22.5%), and diabetes mellitus (22.5%). A total of 103 complications occurred, both infectious (68, 66%) and non-infectious (35, 34%). The most common infectious complication was peritonitis (45, 66.2%); the most frequent non-infectious complication was catheter displacement (13, 37.1%). Seven patients left the peritoneal dialysis program. Of these, three died, two lost function of the peritoneum as a dialysis membrane, one received a kidney transplant and one recovered kidney function. Survival was 100% at one year, 97% at 2 years, 93.2% at 3 and 4 years, and 92% at 5 years. However, the peritoneal membrane was functional in 100% of patients during the first 2 years, decreasing to 96% at 3 and 4 years and to 88.6% at 5 years. CONCLUSIONS: In our setting, peritoneal dialysis attained outcomes similar to those obtained internationally, which supports its usefulness as a renal replacement therapy method in Cuban patients with end-stage renal disease.

Chronic kidney disease in Cuba: epidemiological studies, integral medical care, and strategies for prevention.

The experience of the Republic of Cuba regarding epidemiological studies, integral medical care, and strategies for the prevention of chronic kidney disease is summarized in this report. Cuba has a National Program for Chronic Renal Disease, Dialysis, and Renal Transplantation. There is a national nephrology net, integrated by the Institute of Nephrology as the coordinator center, that has 47 nephrology services with a hemodialysis unit (24 of them with peritoneal dialysis unit), 9 transplantation centers, 33 organ procurement hospitals, and 5 histocompatibility laboratories. In 2004, the incidence rate in dialysis patients was 111 pmp, and the prevalence rate was 149 pmp, demonstrating an increasing mean of 17.0% and 10.0% per year, respectively. Renal transplantation rate was 16.6 pmp. The detection, registration, and follow-up of patients with chronic kidney disease (serum creatinine > or =1.5 mg/dL or glomerular filtration rate <60 mL/min) by family doctors was 9,761 patients, 0.87 patients per 1,000 inhabitants. In the 1980s, three population-based screening studies were performed to define the burden of chronic renal failure in different regions of Cuba. The prevalence rate was 1.1, 3.3, and 3.5 per 1,000 inhabitants, respectively. At present, another three population-based screening studies are ongoing in order to detect the chronic kidney disease in earliest stages. The continuing medical education activities have been very useful in raising the awareness of medical doctors and the basic health staff about the threats posed by and the strategies to prevent, diagnose, and treat chronic kidney disease.

Primary health care strategies for the prevention of end-stage renal disease in Cuba.

End-stage renal disease (ESRD) is a major health problem in the world, including Cuba. There is an increasing trend in both the incidence and prevalence of ESRD. Global projections consistently show an increase of patients in maintenance dialysis, and also an epidemic trend in diabetes mellitus and hypertension, two diseases that are leading causes of ESRD in most countries. A new paradigm is necessary to handle this major health problem, such as a public health model that integrates health promotion and disease prevention. In 1996, the Ministry of Public Health of Cuba launched a national program for the prevention of chronic renal failure (CRF). The progressive implementation of this program follows several steps: the analysis of the resources and health situation in the country; epidemiological research to define the burden of CRF; continuing education for nephrologists, family doctors, and other health professionals; and reorientation of primary health care toward increased nephrology services, intervention, and surveillance. The main outcomes of the program have been: a rational redistribution of nephrology services in corresponding health areas of primary health care; nephrologists being brought closer to the community; an improvement in the knowledge and ability of family doctors and nephrologists in the prevention of chronic renal disease; an increase in the number of patients with CRF (serum creatinine > or = 133 micromol/L or > or = 1.5 mg/dL, or a glomerular filtration rate < 60 mL/min) who are registered in primary health care every year, from a prevalence of 0.59 per 1,000 inhabitants at the beginning of the program in 1996 to 0.92 per 1,000 inhabitants in 2002, with a mean prevalence growth of 9.2% per year; a significant reduction (0.1%) in the incidence of viral hepatitis B in dialysis patients after the implementation of vaccination against viral hepatitis B in CRF patients who are registered in primary health care; and the implementation of CRF surveillance in primary health care, which provides periodic information on CRF burden, patterns, and trends to assist evidence-based public-health decision making, and measures the impact of interventions in the population. Primary health care is an essential tool, and the community is an appropriate social space for health promotion and the prevention of CRF and ESRD.

Uso del prazosín en el tratamiento de la hipertensión arterial moderada y severa / Use of prazosin in the treatent of moderate and severe arterial hypertension

Se empleó una nueva droga, el prazosín, en asociación con propranolol y furosemida a dosis fija, con la finalidad de conocer su efecto hipotensor. Esta se utilizó en 16 pacientes hipotensos moderados y severos por un período de 3 a 5 meses. Se hicieron cortes comparativos en pre y postratamiento de los promedios de la presión arterial sistólica, diastólica y media, al decúbito supino y prono, así como de la frecuencia del pulso y peso. Los promedios de reducción de las cifras tensionales sistólicas y diastólicas fueron de 24 y 22 mm de Hg en posición acostado y de 28 y 27 mm de Hg en posición de pie. La efectividad expresada por la reducción de la tensión arterial, se logró en 14 de 16 pacientes tratados, para un 87

(P < 0,01 a 0,0001). Se plantea que si se consideran los pacientes cuyas presiones diastólicas fueron inferiores a 100 mm de Hg, la efectividad se logró sólo en un 63

. Se señala que no hubo variaciones significativas del peso y la frecuencia cardíaca ni se informaron signos secundarios de importancia, con excepción de ligera hipotensión postural. Se concluye que el prazosín fue efectivo en el tratamiento de la hipertensión arterial moderada y severa con respuesta rápida a dosis relativamente bajas y con escasos efectos secundarios (AU)

Uso del prazosín en el tratamiento de la hipertensión arterial moderada y severa / Use of prazosin in the treatment of moderate and severe arterial hypertension

Se empleó una nueva droga, el prazosín, en asociación con propranolol y furosemida a dosis fija, con la finalidad de conocer su efecto hipotensor. Esta se utilizó en 16 pacientes hipotensos moderados y severos por un período de 3 a 5 meses. Se hicieron cortes comparativos en pre y postratamiento de los promedios de la presión arterial sistólica, diastólica y media, al decúbito supino y prono, así como de la frecuencia del pulso y peso. Los promedios de reducción de las cifras tensionales sistólicas y diastólicas fueron de 24 y 22 mm de Hg en posición acostado y de 28 y 27 mm de Hg en posición de pie. La efectividad expresada por la reducción de la tensión arterial, se logró en 14 de 16 pacientes tratados, para un 87% (P < 0,01 a 0,0001). Se plantea que si se consideran los pacientes cuyas presiones diastólicas fueron inferiores a 100 mm de Hg, la efectividad se logró sólo en un 63%. Se señala que no hubo variaciones significativas del peso y la frecuencia cardíaca ni se informaron signos secundarios de importancia, con excepción de ligera hipotensión postural. Se concluye que el prazosín fue efectivo en el tratamiento de la hipertensión arterial moderada y severa con respuesta rápida a dosis relativamente bajas y con escasos efectos secundarios